Docetaxel is an antineoplastic chemotherapy drug, used to inhibit or stop the development of cancerous tumors. Taxotere is the brand name for docetaxel. The drug is manufactured by Sanofi, a French multinational pharmaceutical corporation. A generic version of docetaxel, manufactured by Hospira, was approved in 2011.
Docetaxel belongs to a class of drugs known as taxanes, all of which were initially derived from the bark of Pacific Yew trees. Most taxanes used to treat cancer now are created synthetically in the lab, although this process is still difficult due to their complex molecular structure. The taxane class also includes paclitaxel, another drug used in chemotherapy regimens.
What Is Docetaxel Used To Treat?
Docetaxel is FDA approved to treat:
- locally advanced or metastatic breast cancer
- non-small cell lung cancer
- advanced stomach cancers
- metastatic prostate cancer
- head and neck cancers
Researchers are currently investigating the drug’s efficacy in treating ovarian, bladder and pancreatic cancers, according to Chemocare.com, along with melanoma and soft tissue sarcomas. Some patients will receive docetaxel for an unapproved use as part of a clinical trial.
How Is Docetaxel Administered?
Docetaxel is not available in a pill or tablet form. The drug is administered intravenously, through an IV inserted into the patient’s vein.
Most patients receive docetaxel in the hospital, their doctor’s office or a cancer treatment clinic. Prior to treatment, the majority of patients will be prescribed a corticosteroid, a steroid hormone, to reduce the severity of docetaxel’s side effects, most notably fluid retention and hypersensitivity (allergic) reactions. These additional medications are usually started one day before an infusion and continue for a total of three days.
The proper dosage of docetaxel will be chosen by a cancer doctor. Dosages vary based on the type of cancer being treated, its stage, a patient’s height, weight and medical history. Treatment schedules will also vary depending on individual factors. Most patients receive a new infusion every one to three weeks. Each infusion usually takes around an hour, Cancer Research UK reports. Docetaxel is often administered as one part of combination therapy, given alongside additional chemotherapy agents.
How Does Docetaxel Kill Cancer Cells?
Docetaxel is a mitotic inhibitor, which means that it disrupts cellular division, a process known as “mitosis” in cellular biology. To be more specific, docetaxel helps to harden the microtubule structure inside cells. Microtubules act like a skeleton inside cells, but to divide properly, microtubules need to be flexible. After being hardened by docetaxel, cancer cells aren’t able to divide, which ultimately leads to cellular death.
Unfortunately, chemotherapy doesn’t distinguish between cancer cells and healthy cells. Cancer cells, however, divide continuously, unlike healthy cells. That means cancer cells are more sensitive to drugs, like docetaxel, that interrupt cellular division. It’s also why the effect of a chemo agent is most pronounced in cancerous cells. But chemo agents destroy all cells, healthy and cancerous alike. Cell-cycle specific drugs only kill cells once the cells have reached a certain point in cellular division. Cell-cycle non-specific drugs, on the other hand, are able to destroy cells even when they are at rest. Docetaxel is cell-cycle specific.
Side Effects Of Docetaxel
Like every chemotherapy drug, docetaxel can cause a wide range of side effects, from mild to severe. No patient will experience every possible side effect, and no two patients will experience the same set of side effects. The following discussion of docetaxel side effects is not complete. Docetaxel side effects often vary depending on which type of cancer the drug is being used to treat. Combining docetaxel with another chemo agent can increase the rate of side effects, sometimes drastically.
However, many people will experience severe side effects while being treated with docetaxel. Your doctor has made a decision that the risk of allowing a cancer to spread is greater than the risk of any one chemotherapy side effect.
With that being said, pay close attention to any side effects that you experience. Don’t ignore a red flag, even if it’s something your doctor didn’t warn you about beforehand. Always consult with your physician if you experience side effects, even ones that you don’t think are being caused by docetaxel. It doesn’t hurt to make sure.
Infusion Side Effects
Complications at the infusion site are rare and usually mild:
- darkened vein
- swollen vein
- red or dry skin
Docetaxel contains alcohol and some patients feel drunk after being injected with the drug. The feeling can be intensified if you take other drugs that cause sleepiness, like narcotics or some medicines for depression. Alcoholic beverages should be avoided on the day of treatment, if not cut out entirely throughout the treatment regimen. Discuss your alcohol consumption and any other medications you take with a doctor to be safe.
Some patients will experience an allergic reaction after being administered docetaxel, usually only in the first or second infusions. Your doctor will likely prescribe corticosteroids beforehand to reduce the risk of an allergic reaction. Patients are monitored closely during treatment to watch for signs, including rashes, fevers, skin flushing and decreased blood pressure.
Common Side Effects
Clinical studies have shown that the following side effects occur in more than 30% of docetaxel patients:
- low white blood cell count (can increase risk of infection)
- low red blood cell count (also known as anemia)
Doctors can accurately predict when a chemotherapy patient’s blood counts will hit a low point. Where docetaxel is concerned, white and red blood cell counts generally begin to drop between four and seven days after a treatment cycle, reaching their lowest point, or nadir, at around five to nine days. Blood counts should return to normal within 21 days of treatment.
- fluid retention and associated weight gain (swelling usually occurs in the ankles or abdomen)
- fatigue and weakness
- mouth sores
- hair loss
- changes in nail color
- altered sense of taste
In rare cases, nails can fall off entirely, but should grow back after treatment has ended. Hair loss is extremely common during docetaxel treatment and may be permanent in between 3% and 15% of patients. The drug often causes extreme and vomiting. Your doctor will most likely prescribe an anti-emetic, or anti-nausea, drug to help with these symptoms. Contact your doctor immediately if you experience severe nausea and vomiting that makes it difficult for you to eat or drink.
Less Common Side Effects
The following side effects have been shown to occur in between 10% and 29% of docetaxel patients:
- muscle, bone and joint pain
- low platelet count (can increase risk of bleeding)
- abnormalities in blood tests that monitor liver function
Elderly patients may be more likely to experience some docetaxel side effects, including anemia, diarrhea, infection, mouth sores and weight loss.
Serious Side Effects To Discuss With Your Doctor
Side effects that impact your ability to perform daily functions should always be reported to a doctor. Here are potential symptoms of treatment that, while not medical emergencies, should be discussed with a healthcare professional:
- nausea and vomiting that interferes with your ability to eat
- diarrhea (4 – 6 episodes in a single day)
- black or bloody stool
- abnormal bleeding or bruising
- purple or reddish spots under the skin
- redness and peeling of the skin
- peripheral neuropathy (numbness in fingers and toes)
- extreme fatigue
- jaundice (yellowing of the eyes or skin)
- upper stomach pain
- loss of appetite
- pale skin
- difficulty breathing or rapid heart rate
- flu-like symptoms (fever, chills or body aches)
- fluid retention (swelling in ankles or feet, difficulty urinating)
- vision problems
Several side effects of docetaxel treatment can increase your risk of contracting infections. Avoid crowds and other people who may be sick. Contact your doctor immediately if you develop symptoms of an infection, like fever, chills, sore throat or a cough.
Avoid grapefruit and grapefruit juice while being treated with docetaxel. Grapefruit can worsen the chemotherapy drug’s side effects.
Pregnancy & Fertility
Docetaxel is not appropriate for pregnant patients. Like most chemo drugs, docetaxel can harm a developing baby. Contraception should be used during treatment, for both men and women. Following the end of docetaxel treatments, patients should continue using contraception for at least six months. Discuss any concerns you have about sexual activity or pregnancy with your doctor.
Chemotherapy can cause long-term changes in fertility. Docetaxel can alter the way a patient’s ovaries work, either reducing or eliminating the amount of eggs produced. These changes can be permanent or temporary. During treatments, some women will stop having their periods, or begin menstruating at irregular intervals.
In the days following a treatment, chemotherapy drugs can be excreted through body fluids, along with feces. After you receive an infusion, avoid allowing your own body fluids to come into contact with your hands or surfaces. If you have sex following an infusion, use a condom to prevent semen or vaginal fluid from touching your partner. Breastfeeding should be avoided, during treatment and for several months after.